If you are an employee who has been injured on the job as a result of conditions or circumstances at your workplace, it is relatively common to believe that your recourse is to sue your employer to recover damages and get compensation for the injury you suffered.

In reality, however, personal lawsuits against an employer by an employee are rare because of the development of the workers’ compensation system. The workers’ compensation system deals with employee injuries, seeks to streamline the process, and protects all involved by avoiding lawsuits and providing a quicker route to compensation.

Fault and Workers’ Compensation in Hamilton Township

As a part of most lawsuits for injuries that a plaintiff has experienced, the plaintiff must be able to show that the defendant is at fault for the injury and damages that occurred. A plaintiff injured in a car accident, for example, cannot sue a random pedestrian for the injuries that he or she experienced.

Proving fault can be complicated, expensive, and requires convincing a jury that the defendant should be made to pay for the injuries the plaintiff suffered.  It also means that, until a case is over or has settled, the plaintiff may not be entitled to any compensation at all.

In order to provide a more speedy system for protecting workers and compensating them for injuries that they have experienced, New Jersey and other states created workers’ compensation systems that allow workers to make an immediate claim for an injury that occurred on the job and start receiving medical benefits and lost wages as soon as possible.

Unlike a personal injury lawsuit, a workers’ compensation claim does not require an employee to show that the employer was at fault. That is, although the employee must show the injury is related to his or her job, there is no need to show that the employer did anything in particular that was wrong or is responsible for the injury suffered. Whether an employee slipped because of an unclean floor or because of he was daydreaming is irrelevant in a workers’ compensation claim.

With workers’ compensation, a plaintiff gives up his or her right to seek a lawsuit and show fault in exchange for the ability to seek more immediate benefits and get coverage for injuries as quickly as possible.

The Difference in Damages

In addition to giving up the freedom to file a lawsuit and show fault, the other trade-off in a workers’ compensation system is the type of damages that an employee may recover. In New Jersey, under the workers’ compensation system, an employee who is injured on the job can recover his or her actual medical expenses and time away from work. What the employee cannot recover is any sort of damages for “pain and suffering” that the employee experienced.

This is different from a personal injury lawsuit. In a lawsuit, one of the most significant types of damages that can be recovered are damages for pain and suffering. These damages try to compensate an employee for the intangible harm that might have occurred and sometimes to punish the employer for what it did.

Damages for pain and suffering can be very significant in a case where the jury feels that an egregious injury has occurred or that the employee has been significantly impacted by his or her injury. It can take into account all sorts of damages that must be estimated by the jury.

As a trade-off for allowing an employee more immediate access to benefits (and certainty about what types of benefits might be received), the New Jersey’s workers’ compensation system does not award employees money for pain and suffering. Rather, it only pays for actual medical expenses that have been incurred.

Likewise, rather than leaving the calculation of an award up to a jury, the workers’ compensation system sets forth benefits based upon a pre-set “schedule of disabilities” that is determined by statute.  This compromise is an attempt by the legislature to make the process as fair as possible for all involved.

New Jersey Attorneys Helping You Pursue Your Claim

In certain limited instances, there are exceptions that allow employees to sue employers for injuries they incurred on the job – such as when the injury was the result of an intentional act by the employer. Although rare, this is something that should always be considered by employees when evaluating their route to recovery.

Some of the most common issues we successfully handle for our workers’ compensation clients are outlined below.

  • The insurance company’s initial denial (rejection) of a workers’ comp claim based on a number of different reasons:
    • Failure of employee to notify employer in a timely manner
    • Failure of employee to seek medical treatment for a work-related injury in a timely manner
    • Determination that the injury was suffered outside the scope of employment
    • Determination that the injury was not suffered at a place of employment (this may include a determination that the injury was pre-existing)
    • Determination that the incident leading to injury is exempt from workers’ comp insurance coverage (e.g., self-inflicted injury, injury caused as a result of horseplay, injury caused because of impairment due to alcohol or drugs)
  • The insurance company’s decision to not pay (or discontinue payment of) medical expenses based on the following reasons:
    • Determination that the medical treatment is or was provided by an unauthorized physician
    • Determination that the type and/or duration of treatment is or was not authorized
    • Determination that the medical treatment is unnecessary and/or unreasonable
    • Determination that the medical treatment is unrelated to work-related injury
    • Determination that the medical treatment has exceeded a reasonable duration
  • The insurance company’s decision regarding temporary, permanent, partial, and/or total disability:
    • Each of these classifications of disability determine the amount and duration of weekly benefits that an injured employee may receive, and insurance companies may improperly classify a disability in order to pay less benefits.
  • The insurance company’s failure to correctly calculate an injured employee’s average weekly wages:
    • An employee’s average weekly wages prior to the work-related injury is critical in determining the amount of weekly benefits to be paid to an injured employee. Failure to correctly calculate this number may result in lower weekly check amounts.
  • An insurance company’s low-ball settlement offer:
    • In order to resolve an outstanding claim as quickly as possible (for as little money as possible), the insurance company may offer a low-ball amount to settle the claim. In workers’ comp cases, any settlement reached is referred to as a “lump sum settlement.”
  • Unlawful termination of employment because of a work injury:
    • Employers are not required to hold an employee’s position open in every single workers’ comp situation; in many cases, they must hold the job open.
    • There are strict rules and regulations that govern an employer’s duty in this regard; in many cases, employers unlawfully and/or improperly terminate an injured employee’s employment.
    • Moreover, injured employees may be able to return to work with certain restrictions, but employers do not want to deal with the hassle. In these cases, employers fail to provide legally required, necessary accommodations, or they may simply unlawfully terminate employees due to the restrictions.

At Petro Cohen, P.C., our workers’ compensation attorneys frequently assist employees through the workers’ compensation system. When applicable, they can also assist employees in considering a possible lawsuit against an employer. For more information or to make an initial appointment, contact us online or at (888) 675-7607.